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Home My WebLink AboutChange of Contractor All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO-BE ACCEPTED Date: =� °� Permit Number: ��I■�III��I�. 1r' Building Permit Application ' s h Planning and Development Services Building and Code Regulation Division COmmercial Residential 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 PERMIT APPLiCATiON FOR Address: 1 Property Tax ID#: Lot No. Site Plan Name: Block No. Project Name: s; s Ryti c« s.«' w 4r..S; a,-xs. ar +s kz 14, _ rt�'.��rv:u3-'.'�v'. �c,�_, _�:�-a'`,�� ..N^n..._-,. .tl'F++�`..,.s�,'�' '1�.�.r•`vE�.`�.,.:.�-s"'�..vr�� ...-,-.:., n ; 0 .. New electrical Meter Second Electrical Meter }.�`s:3 q,� ?ic�.;:S'� c Gr"."5�� i SAfw�e r>.,�u��`-ter-'tet„'!=§��v,�ti'c�kh°s �,�'x� .,,��aC.��,� LL E�..""1-"is _wk; ,fir�.-�sb.,�+A„. ,-3�'.�"'�t �X 3- .. '�✓ +�, ,+.."3""�rs;-.,c�'�.:' x�. 1: St Lam$. .�-:'�.�'. .w>:-z:§ �.r _,SL E.l's._k3'....�ePi�w�'&9Kr.e�.r�e,4..�r fin^h .y�""'��^a"s'_ ....6.T^w d..•x.�„`5.aar .3ns�c.: Additignal work to be performed under this permit–check all that apply: Mechanical Gas Tank —Gas Piping _Shutters Windows/Doors Pond Electric ^Plumbing Sprinklers _Generator V Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction:$ to 00 6 0 Utilities: _Sewer _Septic , Building Height: M`a.; gi Name M UDAIC Name: Address:—,r Company: /n r+ // City: NO S! 41xl ' State: Address: Zip Code: — Fax: City: State: Phone No. 7 Zip Code: Fax: E-Mail:- Plot//tGI e"J U �Z(? z-g- f„� Phone No Fill in fee simple Title Holder on next page(if different E-Mail from-the Owner listed above) State or County License If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required. DESIGNER/ENGINEER: —Not Applicable MORTGAGE COMPANY: _Not Applicable Name: Name: Address: Address: City: State: City: Stater Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable Name: Name: Address: Address: City: City: Zip: Phone: Zip: Phone: OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated. I certify that no work or•installation has commenced prior to the issuance of a permit. St. Lucie County makes no representation that is.granting a permit will authorize the permit holder to build the subject structure which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such your deed for an restrictions which may apply. �c ation and review u Y ur Home Owners Asso t Y structure.Please consult with.your Y stru y In consideration of the granting of this requested permit,I do hereby agree that I will,inall respects,perform the work in accordance with the approved plans,the'Florida Building Codes and St.Lucie County Amendments. The following building permit applications are exempt from undergoing a full concurrency review:room additions, accessory.structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use WARNING TO OWNER:Your failure to Record a Notice of Commencement may result,in,paying twice for . improvements to your property. A-Notice of Commencement must be recorded.in the'public records of St., obtain financing, consult inspection. If you intend to ob g, Lucie County and posted on the jobslte before the first insp y With lender or an attorneybefore commencingwork or-recordingour Notice of Commencement: Signatu a of Owner Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder . STATE OF FLORIDASTATE OF FLORIDA COUNTY OF C,' COUNTY CIF': Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization Physical Presence or Online Notarization s thiday of Tki a^ 20QV by. " this day of ,20_ by i Name of person making statement. Name of person making statement. Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced C., , Produced (Signature 0 rid U (Signature of Notary Public-State of Florida) AUDREY B.HUZM �.17 .'- Seal Commissio _�z. �� MYCOMMISSION Commission No. EXPIRES:Marc REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION, SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.5/6/20 'I Planning&Development Services Department ® Building&Code Regulations 0 n 2300 Virginia Avenue Fort Pierce,Florida 34982 (772)462-1553 OWNERBUILDER AFFIDAVIT DISCLOSURE STATEMENT F.S.489.103(7)EXEMPTIONS State law requires construction to be done by licensed contractors. You have applied for a permit under an exemption to that law. The exemption allows you,as the owner of your property,to act as your own contractor even though you do not have a license. You must provide direct, on-site supervision of the construction yourself. You may build or improve farm outbuildings, a one-family or two-family residence for your use and occupancy. You may also build or improve a commercial building at a cost not exceeding $75,000.00 as long as it is for your own use or occupancy. You may not build or improve said structures for the purposes of selling or leasing that building. You may not hire an unlicensed person to act as your contractor or to supervise people working on your bui in ; it is your responsibility to make sure that people employed by you have licenses required by state law and o my or municipal licensing ordinances. Initial If you sell or lease a building you have built or improved within one year after construction is complete,then a presumption is created that it was built or improved for sale or lease,which is a viola f this exemption. Initial You may not delegate the responsibility for supervising work to a licensed contractor who is not licensed to perform the work being done. Your construction must comply with all applicable laws, ordinances, buildi and zoning regulations. Initial I understand that the building official and inspectors are not there to design or give advice on how eet the minimum code. Initial I understand that as an owner-builder that any contract disputes with sub-contractors and.I must be handled in a civil court with the advice of an attorney. This department will not mitigate any contract disputes. Initial I understand that if I compensate any person or company for work performed they are required to be licensed in this jurisdiction. If for some reason they do not possess a license,I may be responsible and liabl o the cost of the license. Initial I understand that if any person that is unlicensed and uninsured gets injured on my construction oje t- they may be entitled to workmen's compensation. I could be held liable for all doctor, lawyer and relat a 'cal cost,which could include loss of wages during recovery from their injury. Initial To qualify for this exemption under this subsection, an owner must personally appear and sign the building permit application and initial the above I hereby acknowledge that I have read and understand the above disclosure statement and that I further understand that any violation of the terms of the owner/builder exemption shall be reported by the Building and MZo g Department to the Florida State Department of Professional Regulatio Signed and acknowledged on this day of of 20 Owner/Builder Signature STATE OF FLORIDA COUNTY OF �� ! The for ing instrument was acknowled a before me this_.al day of 20� e oU, by A, A L aho is personally knownt me,or who has produced as identificatio . Signature of Not ype or Print Name of N tary (Seal) Title:Notary Public ion Number SLCPDSD Revis P• A t0REY B.HUMPHREY ,.: PAY C04JItq;'SSI0N#GG 3008V :�• �= L- 6XPlRES:March ,2023derwriters BondedThruNot;,'Y blicUn �„ r.C: